Search PubMed⌕ Search

Biomedical subjects

R J Freeark

Publications and source records attributed to R J Freeark.

At least 37 records · Page 2Linked to original sources
PubMed1984

Gastric outlet and duodenal obstruction from inflammatory pancreatic disease.

During a ten-year period, 16 patients with gastric outlet and duodenal obstruction due to inflammatory pancreatic disease were seen. The cause of obstruction was chronic pancreatitis in ten patients, pseudocysts with associated pancreatitis in five patients, and pancreatic abscess in one patient. All patients had nausea and vomiting, 14 had abdominal pain, and five had weight loss greater than 4.5 kg. Diagnosis was made by plain abdominal film in one case, upper gastrointestinal tract roentgenographic series in 15 cases, and endoscopy in 11 cases. Mobilization of the duodenum relieved the obstruction in two patients. Fixed obstruction remained in 14 patients. This was relieved by gastrojejunostomy in 12 patients. Gastrojejunostomy was combined with drainage of a pseudocyst in three patients, a dilated pancreatic duct in three patients, and a dilated common bile duct in four patients. Obstruction was relieved by pseudocyst drainage in two patients. Associated common duct and pancreatic duct obstruction must be identified preoperatively.

Abscess↗
PubMed1984

Neuropsychologic predictors of operative skill among general surgery residents.

The present study develops a rating scale method for evaluating operative skills, assesses the predictive utility of neuropsychologic tests of nonverbal cognitive and psychomotor abilities in accounting for individual differences in surgical skills, and compares the efficiency of these measures with those of traditional residency selection criteria. According to a multifactorial design, 120 general surgery residents were tested with a neuropsychologic test battery and then rated by attending surgeons on surgical skills exhibited during the course of 1445 surgical procedures. Analysis of the neuropsychologic battery resulted in three factors (complex visuo-spatial organization, stress tolerance, psychomotor abilities) that were statistically unrelated to traditional measures such as Medical College Admission Test and National Board scores. Multiple regression analyses indicated that academic predictors, taken alone, either do not correlate (National Board scores) or correlate negatively (Medical College Admission Test scores) with the surgery ratings. Conversely, neuropsychologic test scores show significant positive correlation (r = 0.68) with the ratings. When both sets of predictor variables are combined, a multiple regression coefficient of 0.80 is found with the ratings, with more than two thirds of the predictive power attributable to the neuropsychologic test scores. These tests may provide a useful addition to traditional methods of predicting operative skills.

Clinical Competence↗
PubMed1983

Mechanical effectiveness of closed peritoneal irrigation in peritonitis.

Peritonitis was produced in rabbits using a human fecal suspension. Catheters for multiple peritoneal lavage then were inserted and continuous irrigation was performed. Contrast material was injected on day 1, 2, or 3 to evaluate the mechanical effectiveness of irrigation. Radiologic studies revealed that contrast material penetrated most or all six regions in all animals. The addition of heparin to the irrigant did not alter the number of regions irrigated. It has been concluded the peritoneal irrigation effectively irrigates most of the peritoneal cavity for up to 3 days.

Animals↗
PubMed1983

"Nonfunctioning" islet cell carcinoma of the pancreas.

Although most pancreatic islet cell tumors are associated with clinically evident hormone hypersecretion, a small group have no obvious signs or symptoms of excess endocrine activity and are termed "nonfunctioning." The clinical course of eight patients with "nonfunctioning" islet cell carcinoma seen during an eight-year period was reviewed. The six men and two women ranged in age from 36 to 68 years (mean--52). The initial complaint in six was a palpable abdominal mass associated with pain, steatorrhea, or jaundice. Two patients presented with abdominal pain that was initially thought to be of biliary tract origin, and the tumor was discovered at operation. Two patients underwent radical distal pancreatectomy and have no gross evidence of residual or recurrent tumor one and two years later. Five had a biopsy and biliary diversion; three of these also had a gastrojejunostomy. Five were given postoperative 5-fluorouracil and streptozotocin chemotherapy. One developed renal dysfunction and was switched to dimethyltriazenoimidazole carboxamide (DTIC) chemotherapy. Three patients are alive four, six, and eight years, respectively, after diagnosis. Two expired two and a half and three years after diagnosis. One patient had only biopsy of peripancreatic nodes, and he expired in one year. "Nonfunctioning" islet cell carcinoma presents with symptoms related to the mass effects of the tumor. An aggressive therapeutic approach utilizing surgery and chemotherapy is advocated for these slow growing neoplasms.

Adenoma, Islet Cell↗
PubMed1982

Evaluation of therapeutic options for pancreatic pseudocysts.

A review of 81 patients with pancreatic pseudocyst was conducted to assess the value of different treatment modalities. Resection was associated with 18% mortality (two of 11 patients) and 36% morbidity. In three of nine patients undergoing external drainage a recurrent pseudocyst developed, and in one additional patient, a pancreatic fistula persisted. Internal drainage by cystogastrostomy (21 patients) resulted in 9.5% mortality and 9.5% morbidity, whereas cystojejunostomy (33 patients) was associated with a 6% mortality and 6% morbidity. Endoscopic drainage through the posterior wall of the stomach was unsuccessful in the two patients in which it was used. Internal drainage into the stomach, duodenum, or jejunum is a safe and effective approach for most pseudocysts. Persistent symptoms following surgical treatment were primarily related to failure to recognize multiple cysts and/or pancreatic duct obstruction and dilation characteristic or chronic pancreatitis.

Adult↗
PubMed1982

An integrated university emergency medicine - trauma program.

UNLABELLED: Systems for prehospital care, emergency medical care, and trauma care clearly overlap educationally, medically, financially, and politically. Most systems have not accomplished separation of this interdisciplinary tangle. To solve this dilemma we have customized an Emergency Medicine and Trauma Service (EM & TS) at a regional trauma medical center. The program (annually): 1)treats 32,000 patients (11,330 are trauma); 2) educates 140 paramedics, residents, students. Physician personnel: Members are fully trained in Internal Medicine, Surgery, or Pediatrics; are members of other academic departments. Each is approved by three chairman: Emergency Department, The physician's specialty, and Surgery, Structure: Board-qualified trauma surgeon always present; other faculty supplement surgical manpower; physicians are salaried; each is responsible to Director of EM & TS; trainees are not included as patient-care manpower. Organization: Academically, EM & TS is a Section of the Department of Surgery; the Section Chief is Director of EM & TS, and is responsible for Emergency Department, prehospital care, and trauma admissions. THE SOLUTION: A vertical responsibility structure to this multidisciplinary system has provided a successful solution and may be tailored to other systems.

Emergency Medicine↗
PubMed1981

The fate of unruptured intrahepatic hematomas.

In 4 year's experience, we admitted 283 patients suffering from severe blunt torso trauma. Sixty-five had serious hepatic injury. Of these, 49 (75.4%) had explosive hemorrhagic hepatic injuries and underwent surgery immediately. The remaining 16 (24.6%) had intrahepatic hematomas (IHHs); three were receiving anticoagulants. Fourteen IHHs were diagnosed by liver-spleen scan within 1 to 3 days after injury, one was diagnosed at autopsy and one during surgery. Nine (56.3%) were successfully treated nonoperatively. Six (37.5%) were initially treated nonoperatively, but required emergency surgery later because of life-threatening complications. The onset of complications occurred from 1 to 28 days after injury. Indications for delayed operative intervention were hepatic abscess with sepsis (four patients) and expanding hematoma and blood loss (two patients). We conclude from this experience that: (1) Patients admitted with blunt torso trauma should undergo liver-spleen scan examinations; (2) IHHs should be treated initially nonoperatively; (3) the observation period for nonoperative management should be at least 28 days; (4) serious sequela of IHHS occur approximately 1 to 28 days after injury; (5) the combination of anticoagulation and IHH is highly lethal and must be treated aggressively; and (6) patient with progressive findings--worsening sepsis, increasing peritoneal findings, evidence of progressive blood loss, or expansion of IHHs--should be treated by urgent surgical intervention.

Adolescent↗
PubMed1977

Blunt torso trauma.

Explore the source record for details and available documents.

Abdominal Injuries↗